As always, there are caveats, and it’s not all good news. For one thing, the average US life expectancy still lags behind that of other peer nations such as Switzerland, Italy, Japan, or Norway (though I will have a bit more to say on this in a moment).
For another, one of the reasons why it seems like US life expectancy is starting to climb again after a few years of falling is that the twin pandemics of drug addiction and COVID both peaked a few years ago, but not before killing a large number of the unhealthiest people in the country. In other words, part of the reason why fewer Americans seem to be dying suddenly is that we’ve just lived through a decade in which a disproportionate number of the most vulnerable Americans died, and there are hence fewer such vulnerable people left in the overall population. This is analogous to a fire burning out: it’s good that the fire is over, but not good that it occurred to begin with, and a lot of residual damage is leftover.
Nonetheless, the overall news is worth celebrating. After several years of declining life expectancy, America seems to be back on the path toward better health outcomes. But what about the fact that America consistently lags behind other developed nations? This too is a fact that is attached to a significant amount of nuance.
We’ve known for a long time that health outcomes – like many other things in the United States – are not evenly distributed. For example, a highly educated professional who earns an above average income and lives in an affluent suburb will, on average, live quite a bit longer than a high school dropout who lives in poverty in the inner city.
Political liberals will see the hand of societal factors at play in such discrepancies: Poor education. Poverty. Poor job opportunities. Discrimination. Reduced access to medical care. Those who are more conservatively inclined on the other hand will attribute these differences to individual behavior: people who are poorer and less educated tend to smoke more, drink more, use more drugs, be more likely to engage in violent behavior, exercise less, and eat more junk food.
The fact is that both sides are correct. The personal and public factors both play a role and can even feed off of each other. For example, to take the issue of violence: if you grow up in an inner city neighborhood you are likely to experience and witness a lot of crime and violence. And having had that behavior modeled for you throughout your childhood, you are then more likely yourself to engage in such behavior, the ramifications of which (for example a criminal record, or a breakdown in stable relationships) can in turn make it much harder to ever escape poverty or get out of that neighborhood, thus perpetuating the cycle.
As a doctor, I don’t have solutions to all of the above, but the two things I can do are 1) Try to make sure we are at least having an honest conversation about the issue (in other words, pointing out that both social factors and personal behavior are important and neither “side” has the full monopoly on the truth), and 2) reinforce for the individuals I do meet that – regardless of what social circumstances they find themselves in – they still have a tremendous amount of control over their own health. Choosing to eat well (or at least as well as your circumstances will allow), exercise regularly, not smoke, and not abuse drugs or alcohol can pay tremendous dividends for your health and longevity.
How big of a dividend? Well, I recently decided to look up the highest and lowest lived zip codes in the United States. The results are as follows:
Stillwell Oklahoma – average age at death 56 years
Chatham County, North Carolina – average age at death 96 years
Here in Massachusetts, the Back Bay area of Boston has a life expectancy of nearly 92 years. On the flip side, just a few miles away in the economically disadvantaged neighborhood of Dorchester, the life expectancy drops to 69.
There are some critically important points to think about when considering these strikingly different outcomes. The first is that taking the average life expectancy of the entire United States can be misleading, because it fails to capture both the stunning success stories and the spectacular failures of our society.
It also is proof that there is nothing inherently dangerous about being an American – Americans fortunate enough to be able to live in a high income zip code (or even just to copy the habits of those that do) have a great chance of living as long, or even longer, than those in other industrialized nations. If we compare the entire United States to, say, Korea, we don’t look that great, but if we compare the healthier parts of the United States to Korea, it turns out that we are in fact doing pretty well.
Finally, it should be a wake up call that – whatever your political leanings – we really do have to wrestle with the fact that many communities across our country have been left behind. Political slogans aside, this is a very complicated problem to solve and I’ll leave it to people smarter than myself to propose how we might remedy that fact, but it should at least be on our collective radar.
